Novel Benchmark for Adult-to-Adult Living-Donor Liver Transplantation. Integrating Eastern and Western Experiences-Reference-Cited by-全球学者库

Novel Benchmark for Adult-to-Adult Living-Donor Liver Transplantation. Integrating Eastern and Western Experiences

Published:2023-07-21 Issue: Volume: Page:
ISSN:0003-4932
Container-title:Annals of Surgery
language:en
Short-container-title:

Author:

Li Zhihao¹,Rammohan Ashwin²,Gunasekaran Vasanthakumar²,Hong Suyoung³,Chen Chih-Yi⁴,Kim Jongman⁵,Hervera Marquez Kris Ann⁶,Hsu Shih Chao⁷,Kirimker Onur⁸,Akamatsu Nobuhisa⁹,Shaked Oren¹⁰,Finotti Michele¹¹,Yeow Marcus¹²,Genedy Lara¹³,Dutkowski Philipp¹,Nadalin Silvio¹³,Boehnert Markus U.¹⁴,Polak Wojciech G.¹⁴,Bonney Glenn K.¹²,Mathur Abhisek¹⁵,Samstein Benjamin¹⁵,Emond Jean C.¹⁵,Testa Giuliano¹¹,Olthoff Kim M.¹⁰,Rosen Charles B.¹⁶,Heimbach Julie K.¹⁶,Taner Timucin¹⁶,Wong Tiffany CL.¹⁷,Lo Chung-Mau¹⁷,Hasegawa Kiyoshi⁹,Balci Deniz⁸,Cattral Mark¹⁸,Sapisochin Gonzalo¹⁸,Selzner Nazia¹⁸,Bin Jeng Long⁷,Broering Dieter⁶,Joh Jae-Won⁵,Chen Chao-Long⁴,Suk Suh Kyung³,Rela Mohamed²,Clavien Pierre-Alain¹

Affiliation:

1. Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Switzerland

2. The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Chennai, India

3. Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea

4. Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

5. Department of Surgery, Samsung Medical Center, Seoul, South Korea

6. Organ Transplant Center of Excellence, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia

7. Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan

8. Department of Surgery, Ankara University School of Medicine, Ankara, Turkey

9. Artificial Organ and Transplantation Division and Hepato-Biliary-Pancreatic Surgery, University of Tokyo, Tokyo, Japan

10. Division of Transplantation, University of Pennsylvania, Philadelphia, PA

11. Division of Abdominal Transplantation, Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX

12. Division of Hepatobiliary, Pancreatic Surgery and Liver Transplantation, University Surgical Cluster, National University Health System, Singapore

13. Eberhard Karls University of Tübingen, Department of General Visceral and Transplant Surgery, Tübingen, Germany

14. Department of Surgery, Division of HPB & Transplant Surgery, University Medical Center Rotterdam, Rotterdam, The Netherlands

15. Liver and Abdominal Transplant Surgery, Columbia University Irving Medical Center, New York, NY

16. Department of Surgery, Division of Transplantation Surgery, Mayo Clinic, Rochester, MN

17. Department of Surgery, The University of Hong Kong, Hong Kong, People’s Republic of China

18. Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, ON, Canada

Abstract

Objective: To define benchmark values for adult-to-adult living-donor liver transplantation (LDLT). Background: LDLT utilizes living-donor hemiliver grafts to expand the donor pool and reduce waitlist mortality. While references have been established for donor hepatectomy, no such information exists for recipients to enable conclusive quality and comparative assessments. Methods: Patients undergoing LDLT were analyzed in 15 high-volume centers (≥10 cases/year) from three continents over 5 years (2016-2020), with a minimum follow-up of one year. Benchmark criteria included MELD ≤20, no portal vein thrombosis, no previous major abdominal surgery, no renal replacement therapy, no acute liver failure, and no ICU admission. Benchmark cutoffs were derived from the 75th-percentile of all centers’ medians. Results: Of 3636 patients, 1864 (51%) qualified as benchmark cases. Benchmark cutoffs including posttransplant dialysis (≤4%), primary nonfunction (≤0.9%), non-anastomotic strictures (≤0.2%), graft loss (≤7.7%), and redo-LT (≤3.6%) at 1-year were below the DDLT benchmarks. Bile leak (≤12.4%), hepatic artery thrombosis (≤5.1%), and CCI® (≤56) were above the DDLT benchmarks, while mortality (≤9.1%) was comparable. The right-hemiliver graft, compared to the left, was associated with a lower CCI® score (34 vs.21, P<0.001). Preservation of the MHV with the right-hemiliver graft had no impact neither on the recipient nor on the donor outcome. Asian centers outperformed other centers with CCI® score (21 vs.47, P<0.001), graft loss (3.0%vs.6.5%, P=0.002), and redo-LT rates (1.0%vs.2.5%, P=0.029). In contrast, non-benchmark low-volume centers displayed inferior outcomes such as bile leak (15.2%), hepatic artery thrombosis (15.2%), or redo-LT (6.5%). Conclusion: Benchmark LDLT offers a valuable alternative to reduce waitlist mortality. Exchange of expertise, public awareness and centralization policy are however mandatory to achieve benchmark outcomes worldwide.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Surgery

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